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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT �......................................................:.. �T--�/�! I , ;Complete in Triplicate) Permit No: .......•.............I....._........I._........_.... This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION ......f l3_ .._`ar...._.__...._ / IT!F --- ..............CENSUS TRACT ....................... w Owner's Name .._....�_.. �..--711C �= Phone _ -- Address .......... /vd. SG 3'r/AIf City _44-T11R&P.............. - .... Contractor's Name ....... .,Ae. %��, / :............................-................License # 1 5.3'' ... Phone Installation will serve: Residence r.Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other --•-•---••--•----------------------•--...... Number of living units:___, ....._ ' Number of bedrooms __ g i �.__Garbd e Grinder ------------ Lot Size ...:........ ......................... Water Supply: Public System and name ................... _-•-=- .— -----:---.. ............ a -------------------Private Character of soil to a depth of 3 feet: Sand n Silt❑ -'Clay ❑ ~Peat❑ Sandy loam JR Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material -------- If yes, type _____________________ . (Plot plan, showing size of lot, location of..system in relation to wells,.buildings, etc. must, be placed on reverse side.) ! NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size-ArXI a_ ...?J.. ........... Liquid Depth .......... Capacity /,0.00...... Type .... Material...................... No. Compartments ..saC.__.........:.. O i Distance to nearest. Well .__ �.._ 1O f � 04 Foundation .. _.. Prop. Line ....1'`� ........_. 4 LEACHING LINE [ ] No. of Lines ... ..J________________ Length of each line----->0.. ----- Total p'/t . Length Ri g ............... D`Box= T e--alter Materiai-l�1rjo- De th-Filter Material---" _. i { ---------- Foundation --••--- - Distance to nearest: Well .............. �eF?......._.._.. Property Line ... ,�� .--_-........ E SEEPAGE PIT. [ j Depth ...... :.:. - Dia ter Number .............•---------•_ Rock Filled Yes ❑ No i r ' e Water Table .Depth..-- `--------•--••------•---=•--•----•.....Rock Size ----------- - (� E I � P Distance to #'earest: Well .......................................-Foundation --..------------__ Prop. Line ....:_._.._._.__..__._. REPAIR/ADDITION(Prev. Sanitation Permit# _________________ Date .....____...............- %ew 0 SepticTank ISpecify Requirements) ........................................................... .................. -•--•---........... .................. ------- Disposal Field (Specify Requirements) ;--•----•------• .................................................... -•-•--,----.----------•----;.......... ------•-----� ..... _....--•.............. ••-•----•--.. ................................................. ............................ •---•------_-_.---------•-- (.._._._.......... ----_... .......-............ f --------- ........ ......................•---------•-------_---_-.--- (Draw existing and required addition on reverse side) [ i I hereby certify that I have prepared this application and that the work will be'.Idone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local-.Heaith'District: Home owner or licen- sed agents signature certifies the following: , "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California"" " F C" u Signed ----- . �...�[4944F .,_ .------------- ----------'-... Owner ; I �.. _ _ _ 4 8y ........ ------_.................. ��`t.:_.+-= Tltle � `: -:.a..---•- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...._ ` c -----•----- --------------------- -------- DATE -- 4-.... ............." ....... BUILDINGPERMIT ISSUED ----••---- -------------•-•------•---.......------•--•-,---------....---------._•..--......:... ...---..._DATE ............................................. ADDITIONAL COMMENTS f.t '" -. k �' - ,,k, �ti :� . . .. ...........................................................f.......:_......._--•._._...__.................. ........................ .------------------------------------------ ........................... ......................................... .. _ .......... _ __. -- .. ._.._. Final Inspection b ...... _ _ .......Date .... .................. SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 E. H. 1-'b8 Rev- 5M 71793 M